Why the Dodo Bird Argument is Important (and why it’s not)

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Are all forms of therapy effective? Saul Rosenzweig concluded in the 1930s, that yes, all modes are effective as long as the clinician is a skilled listener and the patient has a certain degree of readiness.

This argument, called the Dodo Bird Verdict — named after the famed dodo bird in Alice in Wonderland who determined that everyone who raced wins all the prizes — has experienced prevalence in the behavioral health community. Research labs across the world where modalities such as DBT, CBT, and psychoanalysis are measured for effectiveness, frequently find the Dodo Bird appearing in discussions.

Scott Miller’s work takes a different spin on the Dodo Bird Verdict, claiming that, yes, specific intervention techniques may be effective for a given presenting problem, but common factors such as therapist empathy, incorporating client feedback, and the nature of the therapist-patient relationship trump such theoretical constructs to a high degree.

In our co-authored book, Therapy in the Real World, we argue that joining and engagement comprises just one of six core meditational processes that are critical to effective, evidence-informed, real-world practice. The other five are motivational interviewing, cognitive behavioral strategies, acceptance and mindfulness strategies, multi-systemic collaboration, and relapse prevention.

This sets the stage to ponder a fascinating (and impressively executed) bulimia study conducted by Stig Poulsen and Susanne Lunn in Denmark that compared the effectiveness of CBT vs psychoanalysis. To quote this Guardian article:

Even though the participants in the Danish trial received vastly unequal amounts of treatment over an extended timespan – with those given psychoanalysis seeing their therapist far more than those allocated CBT – it was CBT that proved more effective. After five months, 42% of the CBT group had stopped binge eating and purging; for those receiving psychoanalysis the figure was just 6%. After two years, the proportion of the psychoanalysis group who were free from bulimia had risen to 15%. But this was still a long way short of the success of the CBT group after two years (44%), despite the fact that by then it was 19 months since the end of their course of treatment.

Impressive results, yes? Here’s the ringer: the primary researchers were psychoanalysts.

One of the main reasons that the Dodo Bird Verdict has experienced such lasting power is the understandable and important argument that bias toward the orientation of the particular lab conducting the study skews results. That’s why we here at Sound Behavioral Health think that studies like Poulsen and Lunn’s are hugely important, and that the researchers should be applauded for their commitment to science.

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